1. Field of the Invention
This invention relates to a bone cutting device and more particularly to a bone cutting device for creating cylindrical bone plugs for patella-patellar tendon-tibia grafts from bone plugs having other than a cylindrical shape.
2. Description of the Related Art
It has become standard procedure to use autologous patella-patellar tendon-tibia graft originating from the central one-third of the patellar tendon for anterior cruciate ligament (ACL) repair. The bone plugs of this autograft provide efficient healing with the osseous tunnels. Several studies have shown the cylindrical bone plug configuration to be superior to other geometric configurations. A cylindrical configuration provides a tighter fit in the tunnel and increases pull out strength.
As with any surgical procedure, ACL repair faces the concern of operation and anesthesia time. Increased length of operation has been associated with increased bacterial contamination of surgical wound, increased in-hospital mortality, increased post-op observation time, increased risk of hypothermia, short-term decline in Activities of Daily Living, post-op pulmonary complication, increased pain and fatigue, and increased risk for cardiovascular complications. Thus, a decrease in operative time would lead to less complications for the patient. A decrease in operative time would also decrease surgeon fatigue, which would directly increase the concentration of the surgeon towards the procedure.
Two methods have been previously demonstrated as ways to create cylindrical bone plugs on patellar tendon grafts. One of these methods involves the use of a circular oscillating saw to procure cylindrical bone plugs directly from the patient's knee. This technique provides reproducible plugs that are sized and shaped appropriately for the corresponding osseous tunnels. However, this particular saw has been described as cumbersome in the operating room, and there is a risk, although small, of thermal injury to the patient's skin from the heat produced by the body of the saw. Currently, this saw is not used in many institutions due to those reasons. In at least some institutions, grafts are harvested via a pneumatic saw, oscillating bone saw, or an osteotome and mallet. The harvested square grafts are then fashioned into cylindrical bone plugs with a Ronguer. The use of a Ronguer to shape a cylindrical bone plug from a square plug consumes considerable operative time and the plugs are not a standard, reproducible shape; however, this has become the commonly accepted method of shaping previously harvested patella-patellar tendon-tibia autograft bone plugs.